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Home My WebLink AboutEHPR-2-10-4066.TIF A THIS IS NOT A PERMIT Case # EHPR-2-10-4066 CATAWBA COUNTY HEALTH DEPARTMENT Plan Review Application for Environmental Services 1842 SM Environmental Health Plan Review - OSWP EXS_SYSTEM APPLICANT OWNER CONTRACTOR BEAU FULBRIGHT CAROLYN DOCKERY C & C BUILDERS OF NORTH CAROLINA 1723 WELLINGTON AV 1723 WELLINGTON AV PO BOX 126 NEWTON NC 28658- NEWTON NC 28658-9149 IRON STATION NC 28080-0126 (704)483-1696 NAME TO APPEAR ON PERMIT BEAU FULBRIGHT Pin#: 362914237961 SITE ADDRESS: 1723 WELLINGTON AV, Newton, NC DIRECTIONS: STARTOWN RD/ RT ON ROCKY FORD/ RT ON WELLINGTON/ ON RT NAME of SUBDIVISION: KENSINGTON Lot # 14 Section/Block/Phase PROPERTY SIZE: Square Feet Acres 1.039 Date Platted/Recorded TYPE OF FACILITY: House X Mobile Home Dimension of Structure 24 X 57 Bedrooms 4 Basement: No Water Using Fixtures in Basement:No No. in Family 4 Whirlpool Tub : Gal. Capacity: MULTIPLE FAMILY RESIDENCE: Units 1.00 Total Number of Bedrooms DAYCARE: Number of Children RESTAURANT: Seats Square Feet Dining Area Square Feet Foodstand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1st 2nd 3rd OTHER: (Specify) Do you aniticipate any additions to Facility? If so, describe: Has any grading, removal, or addition of soil been done to this property? If so, describe NO Are there easements/right-of-ways recorded on this property? NO Type of Water Supply: Individual Well X Community Well Municipal Semi-Public I understand that this is a formal application for a well permit, Improvement permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for a non-expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well Permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. Date: 1. Signature of Applicant or Agent An Environmental Health Specialist will contact you within 2 working days of application date. If you need further information or assistance please call 828-466-7291 AREA 2 (FOR OFFICE USE ONLY) Zoning Approval: Yes No Zoning Approval UDO Zoning Form A Minimum Setbacks Front 30 FEE NAME DATE AMOUNT Side 15 Existing Tank Check Fee 02/25/2010 $80.00 Rear 30 TOTAL FEES $80.00 Max Hght *If a permit has to be redesigned and / or RETRIPS made to the property, there is an additional $60 charge 02/25/10 15:37 THIS IS NOT A PERMIT W LS #I CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services Improvement Permit ❑ Authorization to Construct ❑ Septic Repair ❑ Septic Expansion ❑ Existing Tank Check New Well Permit ❑ Replacement Well ❑ Well Abandonment ❑ I. Name to Appear on Permit C T C 6~,; ftS DP /'Jc72A/ Cl a4~V4 2. Permit Requested By Q►CI` 67AI 66kr Business Phone 104 4S'7 6762 Address P O. s l.~~ S7A11 rJ L Home Phone 3. Property Owner 2 6 1 Business Phone Address 17 a-:7 L--,, &-t o-4 I- --j Home Phone 4. Name of Subdivision (J>M rw Lot # Section/Block/Phase Property Address .L3 V_.-, e l k-j kv6 Directions to Property: S 61-P 14 tu. At0 I-N-C-1W~4-~ t2 71 ✓1&C)Gy PT~ let la C- cLyt V T0J l a V-J e,7 5. Property Size: Square Feet Acres Date Platted/Recorded 6. TYPE OF FACILITY: House ✓ Mobile Home Dimension of Structure Bedrooms*_ *Any room that will be intended for sleeping at the time of construction or for future consideration should be noted as a bedroom and counted on all applications. The number of bedrooms will be confinned by rooms identified on house plans as a bedroom at the time of building pen-nit issuance. This may prevent the need for system size increase in the future. Basement: ye no Water Using Fixtures in Basement: yes' No. in Family Whirlpool Tub yes/no Gallon Capacity MULTIPLE FAMILY RESIDENCES: Units Total Number of Bedrooms DAY CARE: Number of Children RESTAURANT: Seats Square Feet Dining Area -Square Feet Food stand/Meat Market Floor Space TYPE OF BUSINESS: Number of Employees 1 st 2nd 3rd OTHER: (Specify) 7. Do you anticipate any additions to Facility Yes No If so, describe: VI l S1 8. Has any grading, removal, or addition of soil been done to this property? Yes o if so, describe: 9. Are there easements/right-of-ways recorded on this property? Yes No 10. Is a public water supply available on or adjacent to the above property? Yes / o Check type that is available: [ ] Community well [ ] Semi-public well [ ] County/City/Township water line **If No, a Well Permit must be issued with the Septic Permit.** 11. Well Type Applying For: [ ] Individual well [ ] Community well [ ] Semi-Public well 1 understand that this is a formal application for a well permit, Improvement Permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is valid for 5 years or may be non-expiring under certain specified conditions. Improvement Permits and Well Permits are transferable, but may be revoked if this information, site plans or intended use changes for the proposed facility. An Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable setbacks. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE T ROPERTY, THERE IS AN ADDITIONAL CHARGE." Date al c)dlu Signature of Owner or Agent Catawba County, North Carolina This map product was prepared from the Calawho County. NC, Geographic Information Svslem. N Catawba Comttr has made substantial efforts to ensure the accuracy oflocolion and labeling information contained on this map. Catawba Coumy promotes and recommends the independent PePification of 0111' darn contained on this map product by the user. The Coun y of Catawba, its emplo- ees, agents and personnel disclaim, and shall not be held liable for any and all damages, loss or liabilirn, whelher direct, indirect or consequential which arises or maY arise front this nrap product or the use thereof by any person or entQy. Legend Selected Parcel Number: 3629-14-23-7961 1 inch = 60 feet Prepared for: f ✓ f f.. f~ T'..< 335.21 14- Plat 32=1594 -11.04) 1l 7961 20.00 80.00 =r 113 8, i 1.06A r" `t 1 9850 x:75 80.'00 , t ~~D ~i 1`.02A TI IIS IS NOT A 1, GCA1, 1)0CUMCNT tf Thursday, February 25, 2010 02:39 I'N9 - ~ 1. f 1 CATAWBA COUNTY NC - Parcel Report Information Regarding Selected Parcel(s) Parcel ID: 3629-14-23-7961 Name: DOCKERY CAROLYN Name2: FULBRIGHT BEAU Address: 1723 WELLINGTON AVE Address2: City: NEWTON State: NC Zip: 28658-9149 Account: 180144 Calc Acreage: 1.04 Tax Map: 003AJ 03014 LRK: 92250 Deed Book: 2452 Deed Page: 0128 Subdivision Name: KENSINGTON Subdivision Block: Lots: 14 Plat Book: 32 Plat Page: 159 Building Number: 1723 Street Name: WELLINGTON AV Site Zip: 28658 Township: JACOBS FORK Fire Code: NEWTON RURAL City Code: COUNTY State Road: Total Bldgs Value: $157,200 Land Value: $21,800 Total Value: $179,000 Year Built: 1997 Year Remodeled: Last Sale Date: 4/1/2003 Last Sale Amount: $159,000 Neighborhood: 98 Watershed: Watershed Split: Voter Precinct: P34 E911 District: COUNTY Zoning: R-20 Zoning2: Zoning3: Zoning Split: N Zoning Overlay: ED-O Zoning District: COUNTY Split Zoning Dist: N Split Zoning Dist(1): 0 Split Zoning Dist(2): 0 School District: COUNTY Elementary School: STARTOWN Middle School: MAIDEN High School: MAIDEN School Split: NO P&Z Case Number: Census Tract 2010: 011702 Census Block 2010: 1005 Small Area Plan: STARTOWN Agricultural District: Printed: Thursday, February 25, 2010 02:39 PM CATAWBA COUNTY HEALTH DEPARTMENT Telephone: (704) 465- 270 TDD: (704) 465-8200 - 15 2 l Improve. PermitNuthorization to ConstructXRepair Permit Oper. Permit System Type ` Owner/Agent a 0 f:;lv AAJ tit r:+- j tLe? IL ` Phone 116'5 Ike,- - Address e ,?`Y5i 5k) vi 6(b Subdivision M~.2 ~ ►,3P,'j Section/Block/Phase Lot#~ 1 ww ► Lot e tA-t Directions: ~Cl eVje Facility: House Mobile Home Business Other: Tax Map # _2i:~.r r 341- Multi-family Other Zoning Approval #(JSJ i # Bedrooms q # Seats # Employees Application Rate GPD Flow Hot Tub or Spa yes/tb Special Fixtures 1000 Repair Area os/no Basement yes/& Basement Plumbing yes/no Water Supply: Private Well X Public Type of System: Trench y~ Bed Pump Pump/Panel Panel LPP Other Tank Size: Septic Tank Size }erg « Pump Tank Size Nitrification Field: Total Square Feet Depth of Stone Bed Size Trench Width .34 Total Length of All Trenches -flab Number of Trenches Individual Trench Lengthy/&td /lCU IlCr6 / Feet on Center Maximum Trench Depth Distance of Nearest Well ew-r) *DO NOT INSTALL WHEN WET* Topo Slope Texture Structure 1-7Czrt~t f Clay Min. Soil Wetness /mss" Soil Depth -7 Restric. Hoz. at--" Available space s/nol Overall Class S~ U Comments: I I i i **NO GUARANTEE OR WARRANTY IS IMPLIED OR GIVEN AS TO THE PERFORMANCE OR LENGTH TIME THIS SYSTEM WILL FUNCTION** *Improvement Permit has no expiration date and is transferable, but may be revoked if site plans or intended use changes for the proposed facility. An Authorization to Construct is valid for (5) five years from date issued and is not transferable. Permit Date --C, -'mil /t L Owner/Agent Q•'' ~ Sanitarian - ~2- Installed By 5 A, 1 Date t Sanitari White - Office Blue - Building Inspection Operation Permit Yellow - Owner/Agent Green - Building Insnection Authorization to Construct CATAWBA COUNTY, NC 100-A South West Blvd PLAN INVOICE r--] Newton, NC 28658- 0 (828)465-8399 Thursday, February 25, 2010 184 2 sm www.catawbacountync.gov Plan Case: EHPR-2-10-4066 Invoice Number: INV-2-10-259896 Environmental Health Plan Review Invoice Date: 02/25/2010 Fee Name Fee Amount Existing Tank Check Fee Fixed $80.00 Total Fees Due: $80.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 02/25/2010 Cash -1 $80.00 $0.00 Total Paid: $80.00 Total Due: $0.00 planintioicc;b3aR~)651-If57-1635 ~kSS-6'fd010da749;.rPt 02/25/2010 15:43